Eagle Physical Therapy & Sports Med

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1258 Issued in MT

Legal business name

EAGLE PHYSICAL THERAPY & SPORTS MED

Practice address

15 6TH St S
Fairfield, MT 59436

Phone

(406) 467-3800

Fax

(406) 467-3828

NPI assigned

Apr 22, 2015

Last updated

Apr 22, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Grant D Poor, MSPTNPI 1194740928

Title

Owner

Phone

(406) 467-3800

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Grant Damon Poor, M.S., P.T.

  • Physical Therapist
  • Fairfield, MT
  • NPI 1194740928
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1659768224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 457",
            "address_2": "15 6TH ST S",
            "city": "FAIRFIELD",
            "state": "MT",
            "postal_code": "594360457",
            "telephone_number": "406-467-3800",
            "fax_number": "406-467-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 6TH ST S",
            "city": "FAIRFIELD",
            "state": "MT",
            "postal_code": "59436",
            "telephone_number": "406-467-3800",
            "fax_number": "406-467-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE PHYSICAL THERAPY & SPORTS MED",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-22",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "POOR",
        "authorized_official_first_name": "GRANT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-467-3800",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "1258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NPI",
            "identifier": "1194740928",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Ann Burton, LCPC
• Angela Dailey, LCSW
• Fairfield Drug Inc
• Fairfield Medical Clinic LLP
• Preslie Fleming, MSN, FNP
• Front Range Assisted Living, Inc.
• Frontier Family Practice

• Physical Therapist in Fairfield, MT
• Providers in Fairfield, MT by specialty
• Physical Therapist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.